'Do you guys ever think about dying...?' - Barbie

Pat Allerton reflects on the Barbie movie, the societal questions that it answers and the existential question that it doesn't.

Pat Allerton

Pat Allerton is vicar of St Peter’s Notting Hill, sometimes known as 'The Portable Priest'.

Margot Robbie as Barbie in Greta Gerwig's Box-Office smash hit movie

So I’ve just got home from watching the brand new and much acclaimed ‘Barbie’ at the cinema (don’t worry, I also watched ‘Oppenheimer’ last week). It’s 11pm, my wife and our 8.5 month old daughter are asleep upstairs and despite having church in the morning, I feel stirred to write some thoughts.

First and foremost, huge congratulations to Margot Robbie, Ryan Gosling, the whole cast, crew and team. It’s an absolute belter! Full of laughs from beginning to end. I thoroughly enjoyed myself and would encourage anyone else to go and see it.

But secondly, far from being the shallow, plastic cliché that you might expect, what you actually get is an intelligent, searing critique, albeit somehow gently done, of the world we live in and what’s predominantly wrong with it. Which is, you guessed it, men. Or more specifically, patriarchy.

The film begins in ‘Barbieland’ where everything is seemingly perfect, as encapsulated by Barbie when she describes the day we first meet her as, ‘the best day ever. So was yesterday, and so is tomorrow, and every day from now until forever.’ That is, until we meet Ken (played by the excellent Gosling). It is here that the first inkling of imperfection or wrinkle in their world is detected. As the narrator (voiced by Dame Helen Mirren) makes clear, ‘Barbie has a great day every day, but Ken only has a great day if Barbie looks at him.’ (We’ve all been there guys). His niggling insecurity and consequent competitiveness towards other Kens however, still aren’t enough to wake Barbie from her dream-like state and reveal that all is not well in paradise.

Issues of equality, respect, independence and identity are addressed in a way that left this 'pale, stale male' challenged but not condemned.

That moment arrives unexpectedly, during what appears to be a standard evening with ‘a giant blowout party with all the Barbies, and planned choreography and a bespoke song’ to which Ken is told he should ‘stop by’. The dance is breathtaking, the happiness palpable, and yet suddenly, as if from nowhere, Barbie blurts out the pivotal line in the film, the hinge on which the whole (Barbie) world turns, ‘do you guys ever think about dying?’ Cue the DJ’s vinyl record screeching to a halt, the choreography closing down, the dancers looking at her in disbelief, and the general sense of a serious buzz-kill. ‘Dying to dance’, she disingenuously adds, desperate to keep the party going, to shrieks of relieved delight and Dua-Lipa's return. Disaster averted, reality restored.

Except it’s not, it’s simply avoided. Avoided by everyone that is, bar Barbie. Something has changed for her, she knows it, and she must somehow find out why. That wrinkle in her world (along with the wrinkle on her thigh) turns out to be caused by a tear in the fabric separating her plastic world from the real one.

Long-story short, avoiding spoilers where I can, Barbie and Ken then embark on an eye-opening, perspective-shattering, journey from their world to the real world in order to find out where such unnerving questions (and cellulite) were coming from. Major issues with (or norms within) our world are encountered, from the objectification of women (Barbie receives immediate unwanted attention from all kinds of men), to the totally unmerited respect of any man (with someone even asking Ken if he had ‘the time’). They each go on an existential journey of discovery, with Ken delighted to learn that in the real world, men rule the roost (except for a brief time when he thought that horses did). Inspired with fresh vision, he quickly returns home in order to make some fundamental changes to and establish much of the best practice that he’s witnessed in patriarchal L.A.

I won’t say how things end up, but suffice it to say, issues of equality, respect, independence and identity are addressed in a way that left this ‘pale, stale male’ feeling both challenged but not condemned. Kudos to the team for getting that balance right! However, as big and important as these issues are, and as satisfying an ending as was reached from a social justice warrior’s point-of-view, it struck me that the biggest elephant of all was still left there in the room, or at least charging around on the beach. Because the very question that began her journey, the deepest one that woke her up, is the very one that’s just left hanging, unaddressed and ungrappled with.

The music stops and that is it. And yet don't our hearts long for more?

It’s almost as if that moment of existential angst on the dancefloor (and who hasn’t had one of them), realising the fragility of our own mortality, did nothing more than focus Barbie on the need to lay hold of everything she can in this life, rather than exploring the reality (or not) of the next. Our culture has a word for it. YOLO, if you didn’t know, standing for ‘you only live once’. Which of course is true, whether you’ve got faith or not. But the Christian worldview would go further, saying that whilst indeed you only live once, the Scriptures tell us that you also live forever (or YALF, to coin a phrase). Which sounds ridiculous on the face of it (the concept, not the phrase, although granted, YALF might not catch on). After all, as the creator of Barbie, Ruth Handler, tells us in the film, ‘ideas live forever, humans not so much.’

Unless, of course, they do, or can, which only our creator could possibly make possible. And so Ruth’s appearance raises another interesting question, if she made Barbie, who made Ruth? Only when we’re dealing with questions of this nature can we be positioned to take on the big mama (I was tempted to say ‘daddy’) question of, ‘do you guys ever think about dying?’ Which, of course, every one of us does. You can’t be human and avoid doing so. You’d have to be a doll in a made-up world.

But it’s a frightening thing to do, whether in Barbieland, in England’s green and pleasant land or anywhere for that matter. Because it all just looks so final. Like the music stops and that is it. And yet don’t our hearts long for there to be more? For one more song, for the beat to continue? Dare we hope for resurrection where life and light beat death and darkness? Because as beautiful as this life is, with all its opportunity for growth and freedom, be it in self-revelation and actualisation like Ken (the film ends with him wearing a hoodie that says, ‘I am Kenough’), or greater progress and equality on a socio-political level, experience tells us that until we have an answer for Barbie’s first and biggest question, then our own days here on earth, however good, happy and choreographed, will always be rudely interrupted by the reality of death and its long shadow. Find an answer for that... and let the DJ’s music play.

Article

Assisted dying

Care

Culture

Death & life

13 November 2024

8 min read

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

Ewan Goligher

Ewan is a physician practising in Toronto, Canada.

a doctor consults a tablet against the backdrop of a Canadian flag.

Once again, the UK parliament is set to debate the question of legalizing euthanasia (a traditional term for physician-assisted death). Political conditions appear to be conducive to the legalization of this technological approach to managing death. The case for assisted death appears deceptively simple—it’s about compassion, respect, empowerment, freedom from suffering. Who can oppose such positive goals? Yet, writing from Canada, I can only warn of the ways in which the embrace of physician-assisted death will fundamentally change the practice of medicine. Reflecting on the last 10 years of our experience, two themes stick out to me—pressure, and self-deception.

I still remember quite distinctly the day that it dawned on me that the moral ethos of medicine in Canada was shifting dramatically. Traditionally, respect for the sacredness of the patient’s life and a corresponding absolute prohibition on deliberately causing the death of a patient were widely seen as essential hallmarks of a virtuous physician. Suddenly, in a 180 degree ethical turn, a willingness to intentionally cause the death of a patient was now seen as the hallmark of patient-centered doctor. A willingness to cause the patient’s death was a sign of compassion and even purported self-sacrifice in that one would put the patient’s desires and values ahead of their own. Those of us who continued to insist on the wrongness of deliberately causing death would now be seen as moral outliers, barriers to the well-being and dignity of our patients. We were tolerated to some extent, and mainly out of a sense of collegiality. But we were also a source of slight embarrassment. Nobody really wanted to debate the question with us; the question was settled without debate.

Yet there was no denying the way that pressure was brought to bear, in ways subtle and overt, to participate in the new assisted death regime. We humans are unavoidably moral creatures, and when we come to believe that something is good, we see ourselves and others as having an obligation to support it. We have a hard time accepting those who refuse to join us. Such was the case with assisted death. With the loudest and most strident voices in the Canadian medical profession embracing assisted death as a high and unquestioned moral good, refusal to participate in assisted death could not be fully tolerated.

We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

Regulators in Ontario and Nova Scotia (two Canadian provinces) stipulated that physicians who were unwilling to perform the death procedure must make an effective referral to a willing “provider”. Although the Supreme Court decision made it clear in their decision to strike down the criminal prohibition against physician-assisted death that no particular physician was under any obligation to provide the procedure, the regulators chose to enforce participation by way of this effective referral requirement. After all, this was the only way to normalize this new practice. Doctors don't ordinarily refuse to refer their patients for medically necessary procedures; if assisted death was understood to be a medically necessary good, then an unwillingness to make such referral could not be tolerated.

And this form of pressure brings us to the pattern of deception. First, it is deceptive to suggest that an effective referral to a willing provider confers no moral culpability on the referring physician for the death of the patient. Those of us who objected to referring the patient were told that like Pilate, we could wash our hands of the patient’s death by passing them along to someone else who had the courage to do the deed. Yet the same regulators clearly prohibited referral for female genital mutilation. They therefore seemed to understand the moral responsibility attached to an effective referral. Such glaring inconsistencies about the moral significance of a referral suggests that when they claimed that a referral avoided culpability for death by euthanasia, they were deceiving themselves and us.

The very need for a referral system signifies another self-deception. Doctors normally make referrals only when an assessment or procedure lies outside their technical expertise. In the case of assisted death, every physician has the requisite technical expertise to cause death. There is nothing at all complicated or difficult or specialized about assessing euthanasia eligibility criteria or the sequential administration of toxic doses of midazolam, propofol, rocuronium, and lidocaine. The fact that the vast majority of physicians are unwilling to perform this procedure entails that moral objection to participation in assisted death remains widespread in the medical profession. The referral mechanism is for physicians who are “uncomfortable” in performing the procedure; they can send the patient to someone else more comfortable. But to be comfortable in this case is to be “morally comfortable”, not “technically comfortable”. We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

There is also self-deception with respect to the cause of death. In Canada, when a patient dies by doctor-assisted death, the person completing the death certificate is required to record the cause of death as the reason that the patient requested euthanasia, not the act of euthanasia per se. This must lead to all sorts of moments of absurdity for physicians completing death certificates—do patients really die from advanced osteoarthritis? (one of the many reasons patients have sought and obtained euthanasia). I suspect that this practice is intended to shield those who perform euthanasia from any long-term legal liability should the law be reversed. But if medicine, medical progress, and medical safety are predicated on an honest acknowledgment about causes of death, then this form of self-deception should not be countenanced. We need to be honest with ourselves about why our patients die.

There has also been self-deception about whether physician-assisted death is a form of suicide. Some proponents of assisted death contend that assisted death is not an act of deliberate self-killing, but rather merely a choice over the manner and timing of one's death. It's not clear why one would try to distort language this way and deny that “physician-assisted suicide” is suicide, except perhaps to assuage conscience and minimize stigma. Perhaps we all know that suicide is never really a form of self-respect. To sustain our moral and social affirmation of physician-assisted death, we have to deny what this practice actually represents.

There has been self-deception about the possibility of putting limits around the practice of assisted death. Early on, advocates insisted that euthanasia would be available only to those for whom death was reasonably foreseeable (to use the Canadian legal parlance). But once death comes to be viewed as a therapeutic option, the therapeutic possibilities become nearly limitless. Death was soon viewed as a therapy for severe disability or for health-related consequences of poverty and loneliness (though often poverty and loneliness are the consequence of the health issues). Soon we were talking about death as a therapy for mental illness. If beauty is in the eye of the beholder, then so is grievous and irremediable suffering. Death inevitably becomes therapeutic option for any form of suffering. Efforts to limit the practice to certain populations (e.g. those with disabilities) are inevitably seen as paternalistic and discriminatory.

There has been self-deception about the reasons justifying legalization of assisted death. Before legalization, advocates decry the uncontrolled physical suffering associated with the dying process and claim that prohibiting assisted death dehumanizes patients and leaves them in agony. Once legalized, it rapidly becomes clear that this therapy is not for physical suffering but rather for existential suffering: the loss of autonomy, the sense of being a burden, the despair of seeing any point in going on with life. The desire for death reflects a crisis of meaning. We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

We have also deceived ourselves by claiming to know whether some patients are better off dead, when in fact we have no idea what it's like to be dead. The utilitarian calculus underpinning the logic of assisted death relies on the presumption that we know what it is like before we die in comparison to what it is like after we die. In general, the unstated assumption is that there is nothing after death. This is perhaps why the practice is generally promoted by atheists and opposed by theists. But in my experience, it is very rare for people to address this question explicitly. They prefer to let the question of existence beyond death lie dormant, untouched. To think that physicians qua physicians have any expertise on or authority on the question of what it’s like to be dead, or that such medicine can at all comport with a scientific evidence-based approach to medical decision-making, is a profound self-deception.

Finally, we deceive ourselves when we pretend that ending people’s lives at their voluntary request is all about respecting personal autonomy. People seek death when they can see no other way forward with life—they are subject to the constraints of their circumstances, finances, support networks, and even internal spiritual resources. We are not nearly so autonomous as we wish to think. And in the end, the patient does not choose whether to die; the doctor chooses whether the patient should die. The patient requests, the doctor decides. Recent new stories have made clear the challenges for practitioners of euthanasia to pick and choose who should die among their patients. In Canada, you can have death, but only if your doctor agrees that your life is not worth living. However much these doctors might purport to act from compassion, one cannot help see a connection to Nazi physicians labelling the unwanted as “Lebensunwortes leben”—life unworthy of life. In adopting assisted death, we cannot avoid dehumanizing ourselves. Death with dignity is a deception.

These many acts of self-deception in relation to physician-assisted death should not surprise us, for the practice is intrinsically self-deceptive. It claims to be motivated by the value of the patient; it claims to promote the dignity of the patient; it claims to respect the autonomy of the patient. In fact, it directly contravenes all three of those goods.

It degrades the value of the patient by accepting that it doesn't matter whether or not the patient exists.

It denies the dignity of the patient by treating the patient as a mere means to an end—the sufferer is ended in order to end the suffering.

It destroys the autonomy of the patient because it takes away autonomy. The patient might autonomously express a desire for death, but the act of rendering someone dead does not enhance their autonomy; it obliterates it.

Yet the need for self-deception represents the fatal weakness of this practice. In time, truth will win over falsehood, light over darkness, wisdom over folly. So let us ever cling to the truth, and faithfully continue to speak the truth in love to the dying and the living. Truth overcomes pressure. The truth will set us free.